Basic Information
| Provider Information | |||||||||
| NPI: | 1619933413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAIR | ||||||||
| FirstName: | RITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6940 MICHIGAN RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462682800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178808211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6940 N MICHIGAN RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462682800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172662901 | ||||||||
| FaxNumber: | 3172662916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01053875A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 200343340 | 05 | IN | MEDICAID | 000000244376 | 01 | IN | ANTHEM | OTHER |